I had my first major depressive episode at 27, sixth months before I was to be
married. One day I was happily engaged to the man of my dreams, and the next I
was so anxious and depressed I ended up in the emergency room, where I was
promptly put on Zoloft. Over the next three years, I cycled in and out of
depression (no hypomania). I was pretty desperate and hopeless, and then I
became pregnant. (!) I got off of all medication on the advice of my psych and
promptly fell into a major depressive episode for my entire pregnancy. It was
pure Hell. The day my son was born my depression lifted. The doctor put me on
Depakote and Prozac and for the first time ever, I was truly content and
symptom-free. I have continued to be depression-free for the last six years,
three of which I was only taking Prozac weekly.

One month ago, my borderline mother came to visit. I thought everything was
fine, that I was handling all of her negativity and criticism pretty well, but I
woke up the morning she was leaving in a panic attack. One week later, I went
into a MAJOR depressive episode for the first time in 6 years. My doctor has
prescribed lamictal and upped my prozac. I just don't know if I am borderline,
or just have a lot of the traits since I was raised by a borderline mother! I
did a two year Linehan program in New York city when I was pregnant that saved
my life. But this last time around, my bag of tools are just not working. The
symptoms are too intense. I have never felt so bad or hopeless or suicidal in
my life.... so , my question for you is: I am sure you agree that the Lamictal
is a good idea, but as for the Prozac. Would it really be aggravating me this
way after 6 years?? I had small amounts of hypomania and irritability on it,
but nothing that I couldn't live with... I am so scarred to taper off of it,
and my doctor does not think that's a good idea...but , I have been RAPID cycling this time around, 5 days down, 4 days up, 2 days down , 3 up etc.....

PLEASE HELP. I have 2 little boys who need their mom back. I don't want to
die.

Sincerely,

Dear Ms. H.' --

Perhaps it would reassure you to know that I wrote the following answer to
another woman who asked a similar question this week. In other words, this is a
common question.

We might translate your question to
this one "can an antidepressant cause rapid cycling?"

Even though we have relatively little
specific research on this question, mood experts generally agree that the answer
to this question is yes. Indeed, one of the reasons I can state this so firmly
is that mood specialists consistently suggest gradually tapering any
antidepressant to zero as a standard approach for the treatment of rapid cycling
bipolar disorder. I have summarized the data that we do have about this issue
on my website, under Antidepressant Controversies; see the
section about rapid cycling.

As for your particular circumstance,
is it possible that Prozac is "aggravating you", after six years? I think most
mood experts would agree that this is certainly possible. However, they might
well agree with your psychiatrist as well, that turning it down could just as
easily lead to worsening as it might lead to improvement. For example, your
psychiatrist might think that "borderline personality disorder" is applicable to
you (somebody thought so enough to get you into the specific treatment program
for that, the Linehan program). Because Prozac is a recognized treatment for
borderline personality disorder, which may in some cases even decrease
impulsivity and self harm behavior, your psychiatrist might worry that turning
it down might be associated with an increase in such symptoms.

On the other hand, if one takes a
more "bipolar" perspective, placing greater emphasis on that diagnostic
framework,, then gradually tapering off Prozac might indeed lead to some
improvement. This is a judgment call that should be based on a thorough
understanding of your history and current symptoms. If in doubt, you might seek
a second opinion from a mood specialist. I know that is not easy to obtain,
oftentimes. Good luck with the process --